1. The Heart of the Matter: NCEPOD report 2008
The Cardiologist’s Viewpoint
Dr Laura Corr
Consultant Invasive Cardiologist
Guy’s and St. Thomas’ Foundation Trust

2. BCS representatives Dr Mark Signy, Consultant Cardiologist,
Worthing & Southlands Hospitals NHS Trust
Dr Mike Norrell,
Consultant Interventional Cardiologist
The Royal Wolverhampton Hospitals NHS Trust

3. Cardiologists refer 99% of cases
NCEPOD CABG2008 Table 7

4. Study Questions

5. The ROLE of the CARDIOLOGIST
- Multidisciplinary case planning
- Care of patients awaiting surgery
- Audit

6. The ROLE of the CARDIOLOGIST
- Multidisciplinary case planning
- Care of patients awaiting surgery
- Audit

7. MDT meetings should be... HELD
NCEPOD CABG2008 Table 17

8. MDT meetings should be... PROPERLY CONSTITUTED
Out of the 21 units that held meetings
No cardiologist in 2
No cardiothoracic surgeon in 4
No anaesthetist in 20
NCEPOD CABG2008 Table 18

9. … and ATTENDED
NCEPOD CABG2008 Table 19

10. Cases referred to MDT meetings
Only 25% discussed
Only 5.9% of referrals
Relation to age, gender, EUROSCORE?
41% of cases were elective

11. MDT meetings should… HAVE A CLEAR REMIT
Written protocol for referrals:
- Anatomy
- Co-morbidity
- Stability
Use available evidence
Be open forum for debate
Communicate written outcome

12. MDT meetings for complex PCI
NCEPOD CABG2008 Table 20

13. Joint decision-making for initial PCI
NCEPOD CABG2008 Table 23

15. The ROLE of the CARDIOLOGIST
- Multidisciplinary case planning
- Care of patients awaiting surgery
- Audit

16. Referrals for CABG When is it safe for patients to go home?
How will they be reviewed?
For In-patients:
Who is responsible for their care?
Who should identify and manage preoperative co-morbidities?
How do we ‘track and trigger’ intervention?

17. HOME…. ?

18. Referrals for CABG When is it safe for patients to go home?
How will they be reviewed?
For In-patients:
Who is responsible?
Preoperative co-morbidities – cardiologist, surgeon, other?
‘Track and trigger’ intervention?

19. Care of urgent in-patients
NCEPOD CABG2008 Table 29

20. Management of Comorbidities
NCEPOD CABG2008 Table 38

21. Care of urgent in-patients
NCEPOD CABG2008 Table 32

22. National Institute for Health and Clinical Excellence. (2007)
Acutely ill patients in hospital.
Recognition of and response to acute illness in adults in hospital.
NIHCE

23. “Track and trigger” Increasing use of primary PCI Available 24 /7
Inadequate IP use - change path to suit patient needs

24. The ROLE of the CARDIOLOGIST
- Multidisciplinary case planning
- Care of patients awaiting surgery
- Audit

25. Audit – M & M meetings Held in 43 out of 58 units
822 / 907 cases reviewed (90.6%)
Further 35 to be reviewed (3.9%)
“Not held” in 1 NHS unit; 14 Independent units
BUT 60 cases were reviewed by these surgeons!

26. AUDIT Strongly supported by BCS Data from BCS and BCIS to CCAD
Linked to MINAP

27. without surgeons on board
Shouldn’t do PCI
without surgeons on board
Shouldn’t do CABG
without interventional cardiologists on board